electronic LongTerm Services Supports e LTSS Initiative Overview

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electronic Long-Term Services & Supports (e. LTSS) Initiative Overview October 2, 2019 Liz Palena

electronic Long-Term Services & Supports (e. LTSS) Initiative Overview October 2, 2019 Liz Palena Hall, LTPAC Coordinator, ONC e. LTSS is a joint project of The Centers for Medicare & Medicaid Services (CMS), The Office of the National Coordinator (ONC), the Testing Experience and Functional Tools (TEFT) Grantee states (CO, CT, GA, KY, MD, MN), and e. LTSS community participants made possible by CMS funding.

Agenda • The Need for Interoperability in Long Term Services and Support (LTSS) •

Agenda • The Need for Interoperability in Long Term Services and Support (LTSS) • e. LTSS Project Overview » Phases » Current Activity • e. LTSS Links and Resources • e. LTSS Project Leads 2

The Need for Interoperability in Long Term Services and Support (LTSS) • Especially for

The Need for Interoperability in Long Term Services and Support (LTSS) • Especially for older adults, there is a significant overlap between primary/acute care and LTSS: » Hospitalization (example: broken hip) -> post-acute rehabilitation -> personal care and chore services • Fractured eligibility & payment systems, particularly Medicare and Medicaid, can lead to disconnects between settings of care, treatment goals, and desired health/social outcomes • Interoperable systems have the promise of improving coordination and keeping LTSS person-centered 3

e. LTSS Initiative Timeline e. LTSS Initiative Kick-off Nov ‘ 14 Use Case Complete

e. LTSS Initiative Timeline e. LTSS Initiative Kick-off Nov ‘ 14 Use Case Complete 2015 e. LTSS Final Dataset Published e. LTSS Dataset Harmonization 2016 Round 1 Pilots 2017 Round 2 Pilots e. LTSS Supplemental Begins (e. LTSSv 2) e. LTSS Informative Document (Whitepaper) Published via HL 7 e. LTSS FHIR IG Balloted through HL 7 e. LTSS Dataset to HL 7 e. LTSS FHIR IG Mapping Complete Published via HL 7 2018 2020 2019 e. LTSS Whitepaper Balloted through HL 7 e. LTSS Ballot Reconciliation Complete, Changes Made, Negative Votes Withdrawn IG Tested at HL 7 Connectathon 4

e. LTSS Project Overview: Phases • Phase 1: Identified and harmonized a set of

e. LTSS Project Overview: Phases • Phase 1: Identified and harmonized a set of data items commonly found on LTSS Service Plans to facilitate the capture and exchange of person-centered LTSS service plan data • Phase 2: Piloted data items with TEFT grantee states and vendors to validate the dataset • Phase 3: Continuation of Phase 1 & Phase 2 broken into two Tracks » Track 1: Informative Document – Balloted and published through HL 7, the e. LTSS Informative Document describes how the e. LTSS dataset, consisting of 56 data elements, enables home and community-based services (HCBS) person-centered service plans to be represented for exchange and sharing using FHIR and C-CDA » Track 2: FHIR Implementation Guide (IG) and Testing – The e. LTSS FHIR IG expands the FHIR to e. LTSS mapping from the Informative Document into the HL 7 FHIR IG structure (Profiles, Extensions, Capability Statements, etc. ). IG content will be tested and piloted in coordination with interested organizations 5

e. LTSS Core Dataset: 56 elements Beneficiary Demographics: 10 Elements Person Centered Planning: 11

e. LTSS Core Dataset: 56 elements Beneficiary Demographics: 10 Elements Person Centered Planning: 11 Elements Person Name Person Identifier Type Person Date of Birth Person Phone Number Person Address Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone Number Emergency Backup Plan Assessed Need Preference Person Setting Choice Indicator Person Setting Choice Options Service Options Given Indicator Service Selection Indicator Service Provider Options Given Indicator Service Provider Selection Agreement Indicator Service Plan Agreement Indicator Plan Monitor Name Plan Monitor Phone Number Goals & Strengths: 3 Elements Goal Step or Action Strength https: //bit. ly/2 Wb 4 p. C 7 Plan Information: 1 Element Risks: 2 Elements Plan Effective Date Identified Risk Management Plan Signatures: 12 Elements Service Information: 12 Elements Person Signature Person Printed Name Person Signature Date Guardian/Legal Representative Signature Guardian/Legal Representative Printed Name Guardian/Legal Representative Signature Date Support Planner Signature Support Planner Printed Name Support Planner Signature Date Service Provider Signature Service Provider Printed Name Service Provider Signature Date Service Name Self-Directed Service Indicator Service Start Date Service End Date Service Delivery Address Service Comment Service Funding Source Service Unit Quantity Unit of Service Type Service Unit Quantity Interval Service Rate per Unit Total Cost of Service Provider Information: 5 Elements Support Planner Name Support Planner Phone Number Service Provider Name Service Provider Phone Number Non-Paid Provider Relationship 6

e. LTSS Project Overview: Current Activity • The mappings published in the e. LTSS

e. LTSS Project Overview: Current Activity • The mappings published in the e. LTSS Informative Document were formalized into an e. LTSS Standard for Trial Use (STU) FHIR IG. • The e. LTSS FHIR IG: » Uses existing FHIR resources to provide mappings between the e. LTSS data set and existing FHIR elements » Utilizes US Core and applies other constraints (mostly through the “Must Support” flag) • The May 2019 HL 7 Ballot Cycle approved the STU e. LTSS FHIR IG. The e. LTSS FHIR IG was published in September 2019. • The e. LTSS IG was tested at HL 7’s September FHIR Connectathon. • The e. LTSS Project team is interested in developing relationships with organizations to explore future piloting opportunities 7

e. LTSS Use Case – September 2019 FHIR Connectathon • This use case describes

e. LTSS Use Case – September 2019 FHIR Connectathon • This use case describes the automated generation and transmission of the e. LTSS dataset utilizing the e. LTSS FHIR resource between a beneficiary and a care coordinator using a portal or mobile app. It is intended to provide the beneficiary with a copy of his/her most recent long-term services and supports service plan. • Actors: • Pre-Conditions: • Assumptions and Guiding Principles: » Beneficiary (played by LTCI /Vorro. Health) » Beneficiary Health Portal or mobile app (played by LTCI /Vorro. Health) » Care Coordinator Case management system that collects and records the e. LTSS data (played by Altarum) » » » Beneficiary has registered, knows her patient id and is able to access the portal or mobile app Portal or mobile app is a SMART on FHIR application Portal or mobile app is aware of Care Coordinator FHIR server endpoint Care Coordinator is FHIR enabled Care Coordinator supports the e. LTSS FHIR IG data elements » Care Coordinator has accumulated and recorded the raw data necessary for the e. LTSS service plan (from patient, physicians, LTSS contractors…) 8

e. LTSS Links and Resources • e. LTSS Informative Document, balloted by HL 7:

e. LTSS Links and Resources • e. LTSS Informative Document, balloted by HL 7: http: //www. hl 7. org/implement/standards/product_brief. cfm? product_id=495 • e. LTSS FHIR IG : http: //hl 7. org/fhir/us/eltss/ • e. LTSS Sept 2019 FHIR Connectathon Testing Materials: https: //confluence. hl 7. org/display/FHIR/201909+Care+Planning+and+Management+Track • e. LTSS Wiki on ONC Techlab: https: //oncprojectracking. healthit. gov/wiki/display/Tech. Lab. SC/e. LTSS+Home 9

e. LTSS Project Leads • ONC Project Leads » Stacy Perchem (Anastasia. perchem@hhs. gov)

e. LTSS Project Leads • ONC Project Leads » Stacy Perchem (Anastasia. [email protected] gov) » Elizabeth Palena-Hall (elizabeth. [email protected] gov) • CMS Project Lead » Kerry Lida (Kerry. [email protected] hhs. gov) • Program Manager » Johnathan Coleman ([email protected] com) • Project Manager » Amber Patel ([email protected] com) » Greg White ([email protected] com) • Subject Matter Expert » Jamie Parker (jamie. [email protected] com) • Harmonization Lead » Becky Angeles (becky. [email protected] com) 10